Why Canada's Health-Care System Needs to Be Dragged into the 21st Century

By Jeffrey Simpson

Allen Lane, 371 pages, $32

The delivery and financing of health care in Canada is hugely complex.

In his eighth book, Toronto Globe and Mail political columnist Jeffrey Simpson argues that the history of how our current system evolved is key to understanding the system's present and future.

For political junkies, there is much to enjoy in Simpson's recounting of the details of the evolution of our health-care system; he includes new material based on discussions with some key political players.

In the hands of a less-skilled writer, this material would be tough slogging, but these well-written pages fly by. However, these details have little to do with the realities of the challenges of medicare or any potential solutions.

Simpson writes with a clear ideological bias. He favours increased privatization. With frequent criticisms of those he calls "unreconstructed defenders of medicare" and the Supreme Court justices who ruled on the landmark Chaoulli case and whom he calls "gifted health policy amateurs," he spares no rhetorical disdain.

Unfortunately, Simpson practises much of the same behaviours he criticizes in others.

While the section describing the history of medicare makes engaging reading, the following 120 pages devoted to a description of the current system and comparisons with other countries is more challenging.

Most readers will find the detailed financial analyses too complex and repetitive. Simpson rarely provides context to help understand the billion-dollar numbers discussed.

Those with a background in health policy or economics will quickly see through the selective arguments he presents to support his agenda.

Simpson acknowledges the limitations inherent in comparing Canada to other jurisdictions. But he then proceeds to ignore all of these limitations and spends considerable time exploring how other jurisdictions fund and deliver health care.

His superficial analyses of multiple complex systems that function within different geographical and demographic realities do not help us understand the Canadian system.

One of the most troubling aspects of this book is the lack of understanding Simpson demonstrates in describing private delivery of health-care services. This is, of course, his silver bullet; privatization of health care is his solution to medicare's problems.

The reality is that most medical services in Canada are delivered by a private system of independent practitioners who are paid on a fee-for-service basis.

While proposing a competitive, for-profit system for clinics (no rational explanation is provided on how privatization will save money), Simpson believes our future is best served by making all physicians employees of regional health authorities.

Can you imagine how different regions within Manitoba competing with each other for physician services would bring physician costs down?

Simpson repeatedly refers to the consequences of poverty and social inequity on the health of the population and their impact on health-care costs, but he does not include this fundamental issue in his remedies for our current problems.

In contrast, he chooses to address the lack of a national pharmaceutical plan with an eminently sensible proposition -- "social insurance for drugs" to finance a national drug plan.

Simpson focuses much of his analysis on Ontario, although he does include examples of initiatives from Quebec and Alberta.

Manitoba readers will be disappointed that he ignores much of the health-care reform taking place here. One of the ironies of the title of this book, Chronic Condition, is the insinuation that nothing is changing in health-care delivery in Canada.

While the many changes underway throughout the country may not address the kind of fundamental change that Simpson proposes in how our system is funded and delivered, the Canadian health-care system, like the management of most chronic conditions, continues to evolve.

Alan Katz is a Winnipeg family physician and health-policy research scientist.

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